Colchicine Dosing for Gout
For acute gout flares, colchicine 0.6mg should be administered as 1.2mg (two tablets) initially, followed by 0.6mg (one tablet) one hour later, for a total of 1.8mg over one hour. 1, 2
Acute Gout Treatment Protocol
- Initial dose: 1.2mg (two 0.6mg tablets) at first sign of gout flare
- Follow-up dose: 0.6mg (one tablet) one hour later
- Total acute treatment dose: 1.8mg over one hour
- Repeat treatment: No earlier than 3 days after initial treatment 1
This low-dose colchicine regimen is recommended as it provides comparable efficacy to higher doses with significantly fewer adverse effects. Research has demonstrated that this regimen is effective when the gout attack is caught early (within 36 hours) 2, 3.
Prophylactic Dosing for Gout
For patients requiring prophylaxis to prevent recurrent gout attacks:
- Standard prophylactic dose: 0.6mg daily 2
- Alternative dosing: 0.6mg may be given as 0.3mg twice daily if better tolerated 1
Dose Adjustments
Renal Impairment
- Mild to moderate impairment (CrCl 30-80 mL/min): No dose adjustment required for acute treatment, but monitor closely for adverse effects
- Severe impairment (CrCl <30 mL/min):
- For acute flares: Same dose but repeat no more than once every two weeks
- For prophylaxis: Start with 0.3mg daily 1
- Dialysis patients:
- For acute flares: Single dose of 0.6mg, repeat no more than once every two weeks
- For prophylaxis: 0.3mg twice weekly 1
Drug Interactions
Dose adjustments are required when colchicine is used with strong CYP3A4 inhibitors. For example, with most protease inhibitors:
- Acute gout treatment: 0.6mg (1 tablet) once, do not repeat for at least 3 days
- Prophylaxis: Reduce to 0.3mg daily or every other day 1
Important Considerations
- Timing matters: Treatment is most effective when initiated within 24 hours of symptom onset 2
- Adverse effects: The most common side effects are gastrointestinal (diarrhea, nausea, vomiting)
- Safety profile: Low-dose colchicine (1.8mg over one hour) has a safety profile similar to placebo, while high-dose regimens cause significantly more adverse events 3
- Outdated regimens: The older regimen of continuing colchicine until gastrointestinal side effects develop is no longer recommended 2
Alternative Treatments
If colchicine is contraindicated or poorly tolerated, consider:
- NSAIDs (if no contraindications)
- Oral corticosteroids (especially for polyarticular gout)
- Intra-articular corticosteroid injections (for 1-2 joint involvement) 2
The modern low-dose colchicine regimen (1.8mg over one hour) provides the optimal balance between efficacy and safety for most patients with acute gout flares, while daily 0.6mg dosing is appropriate for prophylaxis.